Provider Demographics
NPI:1194365338
Name:BOUNDS FAMILY MEDICAL
Entity Type:Organization
Organization Name:BOUNDS FAMILY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-809-0882
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MS
Mailing Address - Zip Code:39069-0091
Mailing Address - Country:US
Mailing Address - Phone:601-809-0882
Mailing Address - Fax:601-809-0883
Practice Address - Street 1:870 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MS
Practice Address - Zip Code:39069-5695
Practice Address - Country:US
Practice Address - Phone:601-809-0882
Practice Address - Fax:601-809-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health